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GI Cancers (gastric cancer (gastrointestinal stromal tumours (usually…

- - - - H. pylori
        
        Group 1 carcinogen
        
        chronic gastritis > atrophic gastritis > metaplasia
        
        EBV may also have a role in aetiology
      - dietary factors
        
        dietary nitrates > nitrosamines
      - tobacco smoking
      - genetic abnormality
        
        E-caherin
        
        p53
        
        APC
      - pernicious anaemia
      - partial gastrectomy
    - - intestinal
        type 1
        
        well-formed glandular structures
        
        polypoid or ulcerating lesions with heaped-up rolled edges
        
        intestinal metaplasia in surrounding mucosa
        
        distal stomach
        
        environmental and atrophic gastritis association
      - diffuse
        type 2
        
        poorly cohesive cells
        
        tend to infiltrate gastric wall
        
        may involve any part of the stomach, esp cardia
        
        worse prognosis
        
        loss of E-cadherin expression
        
        similar freq in all geographical areas
        
        common in younger people
    - - symptoms
        
        ~50% asymptomatic
        
        epigastric pain
        
        may be relieved by food and antacids
        
        nausea and vomiting
        
        anorexia and weight loss
      - signs
        
        ~50% have palpable abdominal mass
        
        weight loss
        
        Virchow's node
        
        dermomyositis
        
        acanthosis nigricans
      - at presentation, 67% of patients are stage 3/4 (advanced)
- - - - hyperplastic
        hyperplastic polyposis
      - hamartoma
        Peuts-Jeghers, juvenile polyposis...
      - inflammatory
      - lymphoid
        benign lymphoid polyposis
      - adenoma
  - - - autosomal dominant
      - mutation in APC gene
      - 100s-1000s of colonrectal and duodenal adenomas
      - adenomas develop from 16y
      - CRC at 39y
      - hypertrophy of retinal pigment epithelium common
      - higher incidence of thyroid, pancreatic cancers and hepatoblastomas
      - attenuated FAP has slower progression and tends to affect R colon
    - - HNPCC
      - 3-10% CRC cases
      - mutation in mismatch repair genes
      - autosomal dominant
      - CRc at 40-50y
      - higher incidence of stomach, small intestine, brain, bladder, skin and HPB cancers
  - - - chromosomal instability
      - CpG island methylator affect proximal colon
      - microsatellite instability
    - - liver
      - lung
    - - age
      - diet
      - colorectal polyps
      - obesity
      - FHx
      - smoking
      - IBD
    - - total mesorectal excision
        
        for rectal cancers
        
        abdomino-perineal excision if within 5cm of anus
        permanent colostomy
        
        pre and post-op chemo
      - segmental resection for most CRC
      - radiotherapy unhelpful for tumours proximal to rectum
      - surgical/ablative therapy for lung and liver mets
- - - - common in China, South and East Africa, Iran
      - 5-10 per 100,000 in UK
    - - tobacco
      - alcohol
      - obesity
      - low fruit and veg
  - - - GORD
- - - - smoking
      - alcohol
      - caffeine
      - aspirin
      - diabetes
      - chronic pancreatitis
      - genetic 5-10%
  - - - insulin
      - gastrin
      - VIP
      - glucagon
      - somatostatin
- - - - 5th most common worldwide
      - risk factors
        
        chronic HBV
        
        viral integration
        
        90% of HCC are HBV+
        
        chronic HCV
        
        risk of HCC higher than HBV
        
        alcoholic liver disease
        
        HIV
        
        NAFLD
        
        haemochromatosis
        
        aflatoxin
      - single tumour or multiple nodules
      - differentiated
      - mets to bone and lung
      - serum alpha-fetoprotein raised in 67% of patients
      - filling defects on USS (90%)
- - - - 10% of primary tumours of liver and bile ducts
      - jaundice is frequent with hilar tumours
    - - PSC
      - choledochal malformation
      - painless jaundice
      - bile duct stricture with proximal biliary dilatation